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Impairment of Activities of Daily Living is an Independent Risk Factor for Recurrence and Mortality Following Curative Resection of Stage I-III Colorectal Cancer. J Gastrointest Surg 2021; 25:2628-2636. [PMID: 33825120 DOI: 10.1007/s11605-021-04990-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/16/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND With aging of the population, the number of colorectal cancer patients with impairment of activities of daily living (ADLs) has increased. The Barthel index is a validated tool for assessing functional levels of ADLs. In this retrospective study, we aimed to examine associations of Barthel index scores with recurrence and mortality after curative resection of colorectal cancer. METHODS We retrospectively analyzed data of 815 consecutive patients who had undergone curative resection of stage I-III colorectal adenocarcinoma between January 2009 and December 2017. Preoperative functional levels of ADLs were assessed prospectively using the Barthel index (range, 0 to 100; higher scores indicate greater independence). Recurrence-free survival (RFS) and overall survival (OS) were compared according to Barthel index scores. The Cox proportional hazards model was used to calculate hazard ratios (HRs), controlling for potential confounders. RESULTS Of the 815 patients, Barthel index scores were 40 or lower in 129 (16%), 41-85 in 110 (13%), and 86 or more in 576 (71%). In multivariable analyses adjusting for potential confounders including age and disease stage, scores of 85 or lower on the Barthel index were independently associated with shorter RFS (multivariable HR: 1.74, 95% confidence interval: 1.28-2.37, P<0.001) and OS (multivariable HR: 2.10, 95% confidence interval: 1.45-3.04, P<0.001). CONCLUSIONS Lower scores on the Barthel index are associated with shorter RFS and OS following resection of nonmetastatic colorectal cancer. Further studies are needed to establish treatment strategies for colorectal cancer patients with poor functional capacity.
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Eckstein M, Kimmel C, Bruendl J, Weber F, Denzinger S, Gierth M, Burger M, Hartmann A, Otto W, Breyer J. Tumor budding correlates with tumor invasiveness and predicts worse survival in pT1 non-muscle-invasive bladder cancer. Sci Rep 2021; 11:17981. [PMID: 34504238 PMCID: PMC8429693 DOI: 10.1038/s41598-021-97500-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022] Open
Abstract
Tumor budding is defined as a single cell or a cluster of up to 5 tumor cells at the invasion front. Due to the difficulty of identifying patients at high risk for pT1 non-muscle-invasive bladder cancer (NMIBC) and the difficulties in T1 substaging, tumor budding was evaluated as a potential alternative and prognostic parameter in these patients. Tumor budding as well as growth pattern, invasion pattern and lamina propria infiltration were retrospectively evaluated in transurethral resection of the bladder (TURB) specimens from 92 patients with stage pT1 NMIBC. The presence of tumor budding correlated with multifocal tumors (p = 0.003), discontinuous invasion pattern (p = 0.039), discohesive growth pattern (p < 0.001) and extensive lamina propria invasion (p < 0.001). In Kaplan-Meier analysis, tumor budding was associated with significantly worse RFS (p = 0.005), PFS (p = 0.017) and CSS (p = 0.002). In patients who received BCG instillation therapy (n = 65), the absence of tumor budding was associated with improved RFS (p = 0.012), PFS (p = 0.011) and CSS (p = 0.022), with none of the patients suffering from progression or dying from the disease. Tumor budding is associated with a more aggressive and invasive stage of pT1 NMIBC and a worse outcome. This easy-to-assess parameter could help stratify patients into BCG therapy or early cystectomy treatment groups.
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Affiliation(s)
- Markus Eckstein
- Institute of Pathology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Charlotte Kimmel
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Johannes Bruendl
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Florian Weber
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Stefan Denzinger
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Michael Gierth
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Arndt Hartmann
- Institute of Pathology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Otto
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Johannes Breyer
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany.
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Regmi P, Paudyal A, Paudyal P, Hu HJ, Liu F, Ma WJ, Jin YW, Li FY. Prognostic significance of tumor budding in biliary tract cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 48:160-168. [PMID: 34412954 DOI: 10.1016/j.ejso.2021.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Tumor budding is a significant prognostic indicator for poor survival of several solid tumors. However, due to the lack of a standard scoring system, its clinical application for biliary tract cancer (BTC) is limited. OBJECTIVE To identify the prognostic significance of tumor budding in BTC. RESULTS Tumor budding was associated with poor histologic differentiation, lymphovascular invasion, perineural invasion, lymph node metastasis, positive surgical margin, etc. Tumor budding was a predictor of poor OS in univariate (HR: 4.36; 95% CI 3.15 to 6.02; P < 0.001) and multivariate (HR: 2.95; 95% CI 2.28 to 3.80; P < 0.001) analysis. Similarly, it was also a predictor of poor DFS in univariate (HR: 3.26; 95% CI 2.12 to 4.99; P < 0.001) and multivariate (HR: 3.21; 95% CI 1.90 to 5.40; P < 0.001) analysis. In addition, tumor budding was also associated with advanced T-stage, poor histologic differentiation, lymph node metastasis, positive resection margin, lymphatic invasion, vascular invasion, and perineural invasion. CONCLUSION Results of our study have shown that tumor budding is a strong predictor of poor survival for BTC. The clinical utility of tumor budding as a prognostic marker for BTC should be considered after developing a standard international consensus based on the current evidence.
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Affiliation(s)
- Parbatraj Regmi
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Aliza Paudyal
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Pranita Paudyal
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Hai-Jie Hu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Fei Liu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Wen-Jie Ma
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yan-Wen Jin
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Yan S, Ding H, Zhao X, Wang J, Deng W. Development and validation of a nomogram for further decision of radical surgery in pT1 colorectal cancer after local resection. Int J Colorectal Dis 2021; 36:1499-1506. [PMID: 33864506 DOI: 10.1007/s00384-021-03928-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to develop and validate a nomogram to assist physicians making further decisions on the requirement of a radical surgery for T1 colorectal cancer (CRC) after local excision through preoperative prediction of lymph node metastasis (LNM). METHODS A total of 141 T1 CRC patients were enrolled from January 2013 to August 2020. The independent predictive parameters were determined in multivariate analyses. The nomogram was constructed based on predictors of LNM and its performance was evaluated with respect to its calibration, discrimination, and decision curve analysis. Internal validation by bootstrapping was performed to verify the applicability of the nomogram. RESULTS cN in CT/MRI (N+), histologic type (poorly differentiated, mucinous adenocarcinoma, and signet-ring cell carcinoma), tumor budding (G3), and lymphovascular invasion were identified in the multivariable analysis (p<0.05). The developed nomogram incorporated these four predictors and it yielded good discrimination and calibration, with an area under the curve (AUC) of 0.89 (95% confidence interval [CI]: 0.80-0.97). However, the Japanese guideline yielded an AUC of 0.75 (95% CI: 0.63-0.87). A decision curve analysis showed that the predictive scoring system had a high clinical application value, and the nomogram conferred a greater benefit than the Japanese guideline did (range of threshold within 10%-80%). CONCLUSIONS This study proposed a novel predictive model to assist physicians in making treatment decisions regarding additional surgery after local excision.
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Affiliation(s)
- Shu Yan
- Department of Gastrointestinal Surgery, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, People's Republic of China.,Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, People's Republic of China
| | - Haiyang Ding
- Graduate School of Capital Medical University, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, People's Republic of China
| | - Xiaomu Zhao
- Department of Gastrointestinal Surgery, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, People's Republic of China.,Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, People's Republic of China
| | - Jin Wang
- Department of Gastrointestinal Surgery, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, People's Republic of China. .,Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, People's Republic of China.
| | - Wei Deng
- Department of Gastrointestinal Surgery, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, People's Republic of China. .,Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, People's Republic of China.
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Su CY, Burchett A, Dunworth M, Choi JS, Ewald AJ, Ahn EH, Kim DH. Engineering a 3D collective cancer invasion model with control over collagen fiber alignment. Biomaterials 2021; 275:120922. [PMID: 34126408 DOI: 10.1016/j.biomaterials.2021.120922] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 12/21/2022]
Abstract
Prior to cancer cell invasion, the structure of the extracellular matrix (ECM) surrounding the tumor is remodeled, such that circumferentially oriented matrix fibers become radially aligned. This predisposed radially aligned matrix structure serves as a critical regulator of cancer invasion. However, a biomimetic 3D model recapitulating a tumor's behavioral response to these ECM structures is not yet available. In this study, we have developed a phase-specific, force-guided method to establish a 3D dual topographical tumor model in which each tumor spheroid/organoid is surrounded by radially aligned collagen I fibers on one side and circumferentially oriented fibers on the opposite side. A coaxial rotating cylinder system was employed to construct the dual fiber topography and to pre-seed tumor spheroids/organoids within a single device. This system enables the application of different force mechanisms in the nucleation and elongation phases of collagen fiber polymerization to guide fiber alignment. In the nucleation phase, fiber alignment is enhanced by a horizontal laminar Couette flow driven by the inner cylinder rotation. In the elongation phase, fiber growth is guided by a vertical gravitational force to form a large aligned collagen matrix gel (35 × 25 × 0.5 mm) embedded with >1000 tumor spheroids. The fibers above each tumor spheroid are radially aligned along the direction of gravitational force in contrast to the circumferentially oriented fibers beneath each tumor spheroid/organoid, where the presence of the tumor interferes with the gravity-induced fiber alignment. After tumor invasion, there are more disseminated multicellular clusters on the radially aligned side, compared to the side of the tumor spheroid/organoid facing circumferentially oriented fibers. These results indicate that our 3D dual topographical model recapitulates the preference of tumors to invade and disseminate along radially aligned fibers. We anticipate that this 3D dual topographical model will have broad utility to those studying collective tumor invasion and that it has the potential to identify cancer invasion-targeted therapeutic agents.
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Affiliation(s)
- Chia-Yi Su
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alice Burchett
- Department of Bioengineering, University of Washington, Seattle, WA, United States
| | - Matthew Dunworth
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jong Seob Choi
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Andrew J Ewald
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Cell Biology and Center for Cell Dynamics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Eun Hyun Ahn
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Deok-Ho Kim
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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RHAMM in liver metastases of stage IV colorectal cancer with mismatch-repair proficient status correlates with tumor budding, cytotoxic T-cells and PD-1/PD-L1. Pathol Res Pract 2021; 223:153486. [PMID: 34051513 DOI: 10.1016/j.prp.2021.153486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND During the last decades, the management for metastatic colorectal cancer patients has improved due to novel therapeutic approaches. A mismatch-repair deficient status seems to favour a better response to checkpoint inhibitor therapy, but the question arises whether a specific subgroup of stage IV patients with mismatch-repair (MMR) proficient status should also be considered. RHAMM (Receptor for Hyaluronic Acid Mediated Motility/HAMMR/CD168) is characterized by tumor progression and immunogenicity. Therefore, the aim of this study is to determine whether RHAMM within the CRLM of MMR-proficient patients correlate with a more immunological microenvironment, represented by cytotoxic T-cells, PD-1 and PD-1. METHODS Two patient cohorts of liver metastases from MMR colorectal cancers were included into the study (n = 81 and 76) using ngTMA® technology and immunohistochemically analyzed for RHAMM, cytotoxic T-cells (CD8+), PD-1/PD-L1, intrametastatic budding (IMB) and perimetastatic budding (PMB). RESULTS RHAMM-positive IMB was linked to a higher PD-L1 expression (r = 0.32; p = 0.233 and r = 0.28; p = 0.044) in the center and periphery of the metastasis and RHAMM-positive PMB was associated with a higher expression of PD-1 (r = 0.33; p = 0.0297), and especially PD-L1 (r = 0.604; p < 0.0001 and r = 0.43; p = 0.003) in the center and periphery of the metastasis. IMB and PMB were additionally associated with a higher count of CD8+ T-cells (p < 0.0001; r = 0.58; p < 0.0001; r = 0.53). CONCLUSIONS The RHAMM status can be assessed in IMB/PMB either in biopsies or in resections of colorectal cancer liver metastases. A positive RHAMM status in IMB and/or PMB may be a potential indicator for a checkpoint inhibitor therapy for stage IV colorectal cancer patients with MMR proficient status.
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Mitrovic B, Handley K, Assarzadegan N, Chang HL, Dawson HAE, Grin A, Hutchins GGA, Magill L, Quirke P, Riddell RH, Gray RG, Kirsch R. Prognostic and Predictive Value of Tumor Budding in Colorectal Cancer. Clin Colorectal Cancer 2021; 20:256-264. [PMID: 34099382 DOI: 10.1016/j.clcc.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Tumor budding (TB) is an adverse prognostic factor in colorectal cancer (CRC). International consensus on a standardized assessment method has led to its wider reporting. However, uncertainty regarding its clinical value persists. This study aimed to (1) confirm the prognostic significance of TB, particularly in stage II CRC; (2) to determine optimum thresholds for TB risk grouping; and (3) to determine whether TB influences responsiveness to chemotherapy. METHODS TB was assessed in CRC sections from 1575 QUASAR trial patients randomized between adjuvant chemotherapy and observation. Optimal risk group cutoffs were determined by maximum likelihood methods, with their influence on recurrence and mortality investigated in stratified log-rank analyses on exploratory (n = 504), hypothesis-testing (n = 478), and final (n = 593) data sets. RESULTS The optimal threshold for high-grade TB (HGTB) was ≥ 10 buds per 1.23 mm2. High-grade TB tumors had significantly worse outcomes than those with lower TB: 10-year recurrence 36% versus 22% (risk ratio, 2.00 [95% CI, 1.62-2.45]; 2P < .0001) and 10-year mortality 50% vs. 37% (risk ratio, 1.53 [95% CI, 1.34-1.76]; 2P < .0001). The prognostic significance remained equally strong after allowance for other pathological risk factors, including stage, grade, lymphovascular invasion, and mismatch repair status. There was a nonsignificant trend toward increasing chemotherapy efficacy with increasing bud counts. CONCLUSIONS TB is a strong independent predictor of recurrence. Chemotherapy efficacy is comparable in patients with higher and lower TB; hence, absolute reductions in recurrence and death with chemotherapy should be about twice as large in patients with ≥ 10 than < 10 TB counts.
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Affiliation(s)
- Bojana Mitrovic
- Department of Pathology and Laboratory Medicine, Health Sciences North, Sudbury, ON, Canada; University of Toronto, Toronto, Canada.
| | - Kelly Handley
- Birmingham Clinical Trials Unit, Birmingham, United Kingdom
| | | | | | | | | | - Gordon G A Hutchins
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Laura Magill
- Birmingham Clinical Trials Unit, Birmingham, United Kingdom
| | - Philip Quirke
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Robert H Riddell
- University of Toronto, Toronto, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - Richard G Gray
- Clinical Trial Service Unit & Epidemiological Studies, University of Oxford, United Kingdom
| | - Richard Kirsch
- University of Toronto, Toronto, Canada; Mount Sinai Hospital, Toronto, ON, Canada
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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surveillance and Survivorship Care of Patients After Curative Treatment of Colon and Rectal Cancer. Dis Colon Rectum 2021; 64:517-533. [PMID: 33591043 DOI: 10.1097/dcr.0000000000001984] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Ozawa T, Matsuda K, Ishihara S, Fukushima Y, Shimada R, Hayama T, Nozawa K, Hashiguchi Y. The robust performance of carcinoembryonic antigen levels after adjuvant chemotherapy for the recurrence risk stratification in patients with colorectal cancer. J Surg Oncol 2021; 124:97-105. [PMID: 33848373 DOI: 10.1002/jso.26497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/09/2021] [Accepted: 04/03/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Most guidelines of colorectal cancers (CRCs) recommend evaluating the serum carcinoembryonic antigen (CEA) level during postoperative surveillance to detect tumor recurrence, which originates from postsurgery residual tumor cells. We hypothesized that the postadjuvant chemotherapy CEA level may be the most accurate biomarker to predict tumor recurrence, and we evaluated the prognostic significance of the postadjuvant chemotherapy CEA level in patients with stage II and III CRCs. PATIENTS AND METHODS We retrospectively analyzed the cases of 150 Stage II-III CRC patients who had undergone curative surgery and adjuvant chemotherapy. Preoperative, postoperative, and postadjuvant chemotherapy CEA levels were evaluated, and their associations with recurrence-free survival (RFS) were assessed. RESULTS The Kaplan-Meier curves showed that a high preoperative CEA level, high postoperative CEA, and high postadjuvant chemotherapy CEA were associated with poor RFS (p = .001, .0001, and .001, respectively). The multivariate analysis demonstrated that high postadjuvant chemotherapy CEA was an independent factor for poor RFS (HR 2.55, 95% confidence interval: 1.08-6.05, p = .033), whereas high preoperative and postoperative CEA levels were not. CONCLUSIONS The serum levels of postadjuvant chemotherapy CEA were a strong prognostic biomarker in patients with Stage II-III CRCs who had undergone surgery followed by adjuvant chemotherapy.
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Affiliation(s)
- Tsuyoshi Ozawa
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Keiji Matsuda
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Ryu Shimada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Tamuro Hayama
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Keijiro Nozawa
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yojiro Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Gan T, Schaberg KB, He D, Mansour A, Kapoor H, Wang C, Evers BM, Bocklage TJ. Association Between Obesity and Histological Tumor Budding in Patients With Nonmetastatic Colon Cancer. JAMA Netw Open 2021; 4:e213897. [PMID: 33792733 PMCID: PMC8017472 DOI: 10.1001/jamanetworkopen.2021.3897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Obesity is associated with increased risk of colorectal cancer (CRC) and a more aggressive disease course. Tumor budding (TB) is an important prognostic factor for CRC, but its association with obesity is unknown. OBJECTIVE To evaluate the association of TB with obesity and other prognostic factors in colon cancer. DESIGN, SETTING, AND PARTICIPANTS This cohort study involved a histological review of colon cancer specimens obtained during 7 years (January 2008 to December 2015) at the University of Kentucky Medical Center; data analysis was conducted from February 2020 to January 2021. Specimens came from 200 patients with stage I to III colon cancer; patients with stage 0, stage IV, or incomplete data were excluded. MAIN OUTCOMES AND MEASURES TB was defined as 1 to 4 malignant cells at the invasive edge of the tumor, independently assessed by 2 academic pathologists. The primary outcome was the association of TB with obesity (defined as body mass index [BMI] of 30 or greater). Secondary outcomes include the association of TB with clinical features (ie, age, race, sex, TNM stage, tumor location) and pathological features (ie, poorly differentiated tumor clusters [PDCs], Klintrup-Mäkinen inflammatory score, desmoplasia, infiltrative tumor border, tumor necrosis, and tumor-to-stroma ratio). RESULTS A total of 200 specimens were reviewed. The median (interquartile range) age of patients was 62 (55-72) years, 102 (51.0%) were women, and the mean (SD) BMI was 28.5 (8.4). A total of 57 specimens (28.5%) were from stage I tumors; 74 (37.0%), stage II; and 69 (34.5%), stage III. Of these, 97 (48.5%) had low-grade (<5 buds), 36 (18.0%) had intermediate-grade (5-9 buds), and 67 (33.5%) had high-grade (≥10 buds) TB. Multivariable analysis adjusting for clinical and histological factors demonstrated that higher TB grade was associated with obesity (odds ratio [OR], 4.25; 95% CI, 1.95-9.26), higher PDC grade (grade 2 vs 1: OR, 9.14; 95% CI, 3.49-23.93; grade 3 vs 1: OR, 5.10; 95% CI, 2.30-11.27), increased infiltrative tumor border (OR, 1.03; 95% CI, 1.01-1.04), cecal location (OR, 2.55; 95% CI, 1.09-5.97), and higher stage (eg, stage III vs stage I for high-grade or intermediate-grade vs low-grade TB: OR, 2.91; 95% CI, 1.00-8.49). Additionally, patients with a higher TB grade had worse overall survival (intermediate vs low TB: hazard ratio, 2.20; 95% CI, 1.11-4.35; log-rank P = .02; high vs low TB: hazard ratio, 2.67; 95% CI, 1.45-4.90; log-rank P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, a novel association between high TB grade and obesity was found. The association could reflect a systemic condition (ie, obesity) locally influencing aggressive growth (ie, high TB) in colon cancer.
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Affiliation(s)
- Tong Gan
- Department of Surgery, The University of Kentucky, Lexington
- The Markey Cancer Center, The University of Kentucky, Lexington
| | - Kurt B. Schaberg
- The Markey Cancer Center, The University of Kentucky, Lexington
- Department of Pathology, The University of Kentucky, Lexington
| | - Daheng He
- The Markey Cancer Center, The University of Kentucky, Lexington
| | - Akila Mansour
- Department of Pathology, The University of Kentucky, Lexington
| | - Harit Kapoor
- Department of Radiology, The University of Kentucky, Lexington
| | - Chi Wang
- The Markey Cancer Center, The University of Kentucky, Lexington
- Department of Internal Medicine, The University of Kentucky, Lexington
| | - B. Mark Evers
- Department of Surgery, The University of Kentucky, Lexington
- The Markey Cancer Center, The University of Kentucky, Lexington
| | - Therese J. Bocklage
- The Markey Cancer Center, The University of Kentucky, Lexington
- Department of Pathology, The University of Kentucky, Lexington
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Prognostic value of desmoplastic reaction characterisation in stage II colon cancer: prospective validation in a Phase 3 study (SACURA Trial). Br J Cancer 2021; 124:1088-1097. [PMID: 33414540 PMCID: PMC7960987 DOI: 10.1038/s41416-020-01222-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/17/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The characterisation of desmoplastic reaction (DR) has emerged as a new, independent prognostic determinant in colorectal cancer. Herein, we report the validation of its prognostic value in a randomised controlled study (SACURA trial). METHODS The study included 991 stage II colon cancer patients. DR was classified by the central review as Mature, Intermediate or Immature based on the presence of hyalinised collagen bundles and myxoid stroma at the desmoplastic front. All clinical and pathological data, including DR characterisations, were prospectively recorded and analysed 5 years after the completion of the registration. RESULTS The five-year relapse-free survival (RFS) rate was the highest in the Mature group (N = 638), followed by the Intermediate (N = 294) and Immature groups (N = 59). Multivariate analysis revealed that DR classification was an independent prognostic factor, and based on Harrell's C-index, the Cox model for predicting RFS was significantly improved by including DR. In the conditional inference tree analysis, DR categorisation was the first split factor for predicting RFS, followed by T-stage, microsatellite instability status and budding. CONCLUSIONS Histological categorisation of DR provides important prognostic information that could contribute to the efficient selection of stage II colon cancer patients who would benefit from postoperative adjuvant therapy.
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Haddad TS, Lugli A, Aherne S, Barresi V, Terris B, Bokhorst JM, Brockmoeller SF, Cuatrecasas M, Simmer F, El-Zimaity H, Fléjou JF, Gibbons D, Cathomas G, Kirsch R, Kuhlmann TP, Langner C, Loughrey MB, Riddell R, Ristimäki A, Kakar S, Sheahan K, Treanor D, van der Laak J, Vieth M, Zlobec I, Nagtegaal ID. Improving tumor budding reporting in colorectal cancer: a Delphi consensus study. Virchows Arch 2021; 479:459-469. [PMID: 33650042 PMCID: PMC8448718 DOI: 10.1007/s00428-021-03059-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/22/2021] [Accepted: 02/14/2021] [Indexed: 02/06/2023]
Abstract
Tumor budding is a long-established independent adverse prognostic marker in colorectal cancer, yet methods for its assessment have varied widely. In an effort to standardize its reporting, a group of experts met in Bern, Switzerland, in 2016 to reach consensus on a single, international, evidence-based method for tumor budding assessment and reporting (International Tumor Budding Consensus Conference [ITBCC]). Tumor budding assessment using the ITBCC criteria has been validated in large cohorts of cancer patients and incorporated into several international colorectal cancer pathology and clinical guidelines. With the wider reporting of tumor budding, new issues have emerged that require further clarification. To better inform researchers and health-care professionals on these issues, an international group of experts in gastrointestinal pathology participated in a modified Delphi process to generate consensus and highlight areas requiring further research. This effort serves to re-affirm the importance of tumor budding in colorectal cancer and support its continued use in routine clinical practice.
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Affiliation(s)
- Tariq Sami Haddad
- Department of Pathology, Radboud University Medical Center, P.O. Box 9101, 6525 GA, Nijmegen, Netherlands.
| | | | - Susan Aherne
- St. Vincent's University Hospital, Dublin, Ireland.,University College Dublin, Dublin, Ireland
| | | | - Benoît Terris
- Cochin Hospital, Paris, France.,University of Paris, Paris, France
| | - John-Melle Bokhorst
- Department of Pathology, Radboud University Medical Center, P.O. Box 9101, 6525 GA, Nijmegen, Netherlands
| | | | | | - Femke Simmer
- Department of Pathology, Radboud University Medical Center, P.O. Box 9101, 6525 GA, Nijmegen, Netherlands
| | | | | | - David Gibbons
- St. Vincent's University Hospital, Dublin, Ireland.,University College Dublin, Dublin, Ireland
| | | | | | | | | | | | | | - Ari Ristimäki
- University of Helsinki, Helsinki, Finland.,HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Sanjay Kakar
- University of California, San Francisco, San Francisco, CA, USA
| | - Kieran Sheahan
- St. Vincent's University Hospital, Dublin, Ireland.,University College Dublin, Dublin, Ireland
| | | | - Jeroen van der Laak
- Department of Pathology, Radboud University Medical Center, P.O. Box 9101, 6525 GA, Nijmegen, Netherlands.,Linköping University, Linköping, Sweden
| | | | | | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, P.O. Box 9101, 6525 GA, Nijmegen, Netherlands
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63
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Mima K, Miyanari N, Kosumi K, Tajiri T, Kanemitsu K, Takematsu T, Inoue M, Mizumoto T, Kubota T, Baba H. The efficacy of adjuvant chemotherapy for resected high-risk stage II and stage III colorectal cancer in frail patients. Int J Clin Oncol 2021; 26:903-912. [PMID: 33507434 DOI: 10.1007/s10147-021-01876-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/12/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The number of frail patients with colorectal cancer (CRC) has increased. Despite evidence-based treatment guidelines, a large proportion of patients with resected CRC do not receive adjuvant chemotherapy in daily practice. This retrospective study aimed to examine the effect of adjuvant chemotherapy for CRC according to frailty. METHODS We retrospectively analyzed data from 507 consecutive patients with curatively resected high-risk stage II or stage III CRC between 2009 and 2016. Frailty was assessed using the Clinical Frailty Scale (CFS): 1 (very fit) to 9 (terminally ill), and frailty was defined as CFS ≥ 4. Recurrence-free survival (RFS) and overall survival (OS) were compared between surgery alone and adjuvant chemotherapy in frail and non-frail patients. A cox proportional hazards model was used to calculate hazard ratios (HRs), controlling for potential confounders. RESULTS Of the 507 patients, 194 (38%) were frail. There were no significant interactions between frailty and adjuvant chemotherapy regarding RFS (Pinteraction = 0.59) and OS (Pinteraction = 0.81). In multivariable analyses, associations of adjuvant chemotherapy with longer RFS and OS in frail patients (RFS, HR: 0.33, 95% CI 0.15-0.63; OS, HR: 0.23, 95% CI 0.08-0.54) were comparable to non-frail patients (RFS, HR: 0.36, 95% CI 0.22-0.58; OS, HR: 0.34, 95% CI 0.15-0.69). Frail patients receiving adjuvant chemotherapy were younger and had better nutritional status than those undergoing surgery alone (all P < 0.005). CONCLUSION Selected frail patients with CRC may experience a similar survival benefit from adjuvant chemotherapy as non-frail patients. Clinical trials are needed to establish adjuvant chemotherapy for CRC in frail patients.
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Affiliation(s)
- Kosuke Mima
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan.
| | - Nobutomo Miyanari
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Keisuke Kosumi
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Takuya Tajiri
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Kosuke Kanemitsu
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Toru Takematsu
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Mitsuhiro Inoue
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Takao Mizumoto
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Tatsuo Kubota
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
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64
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Kim HN, Lee SY, Kim BH, Kim CY, Kim A, Kim H. Prognostic value of tumor budding in gallbladder cancer: application of the International Tumor Budding Consensus Conference scoring system. Virchows Arch 2021; 478:1071-1078. [PMID: 33398430 DOI: 10.1007/s00428-020-03012-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/21/2020] [Accepted: 12/27/2020] [Indexed: 02/06/2023]
Abstract
Tumor budding (TB), a histopathological manifestation of epithelial-mesenchymal transition, is an important step in cancer invasion and metastasis development. TB has been considered a strong prognostic indicator in colorectal cancer. The International Tumor Budding Consensus Conference (ITBCC) scoring system is the standardized method used for patient outcome prediction in several human tumors. We investigated the clinicopathological implications and applicability of TB measured using the ITBCC scoring system in gallbladder cancer (GBC). The TB grades assigned to the 78 GBC patients were as follows: Bd1 (low TB), 41 (52.6%) patients; Bd2 (intermediate TB), 22 (28.2%) patients; and Bd3 (high TB), 15 (19.2%) patients. A higher TB grade correlated with a poorer histological differentiation (P < 0.000), higher pT category (P < 0.000), the involvement of surgical resection margin (P = 0.005), presence of nodal metastasis (P < 0.000), lymphatic and venous invasion (P < 0.000), and perineural invasion (P = 0.004). Univariate Cox regression analysis revealed that a poor histological grade, high pT category, lymphatic invasion, perineural invasion, and intermediate to high TB grades were associated with worse 5-year overall survival and disease-free survival. TB was not significantly associated with death or recurrence risk in multivariate Cox analysis. The interobserver agreement of TB grading was substantial. This study is the first to apply the ITBCC scoring system and suggest the prognostic value of TB in GBC.
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Affiliation(s)
- Han-Na Kim
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Soo Yeon Lee
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Baek-Hui Kim
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Chung-Yeul Kim
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Aeree Kim
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Hayeon Kim
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
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65
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Lang-Schwarz C, Melcher B, Dregelies T, Norouzzadeh Z, Rund-Küffner S, Lang-Schwarz K, Vieth M, Sterlacci W. Adjuvant chemotherapy in stage II and III colon cancer: the role of the "budding and TILs-(tumor-infiltrating lymphocytes) combination" as tumor-host antagonists. Int J Colorectal Dis 2021; 36:1765-1779. [PMID: 33745027 PMCID: PMC8279987 DOI: 10.1007/s00384-021-03896-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE To analyze the influence of adjuvant chemotherapy on the combination of tumor budding and tumor-infiltrating lymphocytes (TILs) in stage II and III colon cancer and to elucidate its potential value for adjuvant treatment decisions. METHODS 306 patients with stage II and 205 patients with stage III colon cancer diagnosed between 2005 and 2016 who had undergone surgery in a curative setting were enrolled. Budding and TILs were assessed according to the criteria of the International Tumor Budding Consensus Conference (ITBCC) and the criteria of the International TILs Working Group (ITWG). Combinations of budding and TILs were analyzed, and the influence of adjuvant chemotherapy was assessed. RESULTS In stage II colon cancer, stratification into the four budding/TILs groups showed no significant differences in overall survival (OS) between the chemotherapy and the surgery-alone group, not even in cases with high-risk features. In stage III colon cancer, patients with low budding/high TILs benefited significantly from chemotherapy (p=0.005). Patients with high budding/low TILs as well as high budding/high TILs showed a trend to benefit from adjuvant treatment. However, no chemotherapy benefit was seen for the low budding/low TIL group. CONCLUSIONS The budding/TIL combination identified subgroups in stage II and III colon cancer with and without benefit from adjuvant treatment. The results this study suggest that the combination of budding and TILs as tumor-host antagonists might be an additional helpful tool in adjuvant treatment decisions in stage II and III colon cancer.
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Affiliation(s)
- Corinna Lang-Schwarz
- Institute of Pathology, Klinikum Bayreuth GmbH, Preuschwitzer Str. 101, 95445 Bayreuth, Germany
| | - Balint Melcher
- Institute of Pathology, Koblenz, Franz-Weis-Str. 13, 56073 Koblenz, Germany
| | - Theresa Dregelies
- Institute of Pathology, Klinikum Bayreuth GmbH, Preuschwitzer Str. 101, 95445 Bayreuth, Germany
| | - Zahra Norouzzadeh
- Institute of Pathology, Klinikum Bayreuth GmbH, Preuschwitzer Str. 101, 95445 Bayreuth, Germany
| | - Stefanie Rund-Küffner
- Department of Internal Medicine, Sana Klinik Pegnitz, GmbH, Langer Berg 12, 91257 Pegnitz, Germany
| | - Klaus Lang-Schwarz
- Department of Anesthesiology, Klinikum Bayreuth GmbH, Preuschwitzer Str. 101, 95445 Bayreuth, Germany
| | - Michael Vieth
- Institute of Pathology, Klinikum Bayreuth GmbH, Preuschwitzer Str. 101, 95445 Bayreuth, Germany ,Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstr. 8-10, 91054 Erlangen, Germany
| | - William Sterlacci
- Institute of Pathology, Klinikum Bayreuth GmbH, Preuschwitzer Str. 101, 95445 Bayreuth, Germany ,Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstr. 8-10, 91054 Erlangen, Germany
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66
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Zhang Y, Liu Y, Qiu X, Yan B. Concurrent Comparison of the Prognostic Values of Tumor Budding, Tumor Stroma Ratio, Tumor Infiltrating Pattern and Lymphocyte-to-Monocyte Ratio in Colorectal Cancer Patients. Technol Cancer Res Treat 2021; 20:15330338211045826. [PMID: 34658263 PMCID: PMC8521422 DOI: 10.1177/15330338211045826] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objectives: Tumor budding (TB), tumor stroma ratio (TSR), tumor infiltrating pattern (TIP), and preoperative lymphocyte-to-monocyte ratio (LMR) were previously reported to be useful prognostic factors in colorectal cancer (CRC); however, the correlation among these markers and their individual prognostic potency have not been extensively studied. Methods: A cohort of 147 stage I-IV CRC patients was obtained retrospectively, and the patients were divided into subgroups based on low or high TB/TSR/LMR, TIPa (expansile + intermediate) and TIPb (infiltrative) values. The differences in relapse-free survival (RFS) and overall survival (OS) intervals among these subgroups were determined by Kaplan-Meier analysis followed by log-rank tests. The Cox proportional hazard model was applied for the univariate and multivariate analysis of RFS and OS rates. Results:TB, TIP, and LMR, but not TSR, are useful markers for predicting patient survival. Patients with a poor histological grade and large tumor diameter were more likely to present with high TB, TIPb, and low LMR values; in addition, those with advanced T, N, and TNM stages and elevated preoperative CA199 levels had high TB and TIPb levels. TB, TIP, and LMR were significant prognostic factors for the RFS (TB: HR [hazard ratio] = 2.28, 95% CI = 1.30-4.00, P < .01; TIP: HR = 2.60, 95% CI = 1.46-4.60, P < .01; LMR: HR = 0.79, 95% CI = 0.65-0.96, P = .02) and OS (TB: HR = 2.43, 95% CI = 1.32-4.48, P < .01; TIP: HR = 2.49, 95% CI = 1.34-4.63, P < .01; LMR: HR = 0.79, 95% CI = 0.64-0.98, P = .03) intervals. In addition, TB and LMR were independent prognostic factors for the RFS interval (TB: HR = 1.80, 95% CI = 1.01-3.19, P = .05; LMR: HR = 0.80, 95% CI = 0.67-0.96, P = .01), but only LMR was an independent factor for OS rates (HR = 0.80, 95% CI = 0.65-0.98, P = .03). Conclusion: Although TB, TIP, and LMR are useful prognostic markers for CRC, the LMR is likely to be the only independent prognostic factor for both RFS and OS outcomes in practice.
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Affiliation(s)
- Yingcheng Zhang
- Department of Traditional Chinese Medicine, Second Affiliated Hospital of Naval Medical University, Shanghai, P.R. China
| | - You Liu
- Department of Pathology, Hainan Hospital of Chinese PLA General Hospital, Sanya, P.R. China
| | - Xiaomei Qiu
- Department of Pathology, Hainan Hospital of Chinese PLA General Hospital, Sanya, P.R. China
| | - Bing Yan
- Department of Oncology, Hainan Hospital of Chinese PLA General Hospital, Sanya, P.R. China
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67
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Prognostic impact of tumor budding in endometrial carcinoma within distinct molecular subgroups. Mod Pathol 2021; 34:222-232. [PMID: 32728223 DOI: 10.1038/s41379-020-0626-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 12/21/2022]
Abstract
Tumor budding is a robust prognostic parameter in several tumor entities but is rarely investigated in endometrial carcinoma. We applied the recently standardized counting method from the International Tumor Budding Consensus Conference for colorectal cancer (ITBCC) on a cohort of 255 endometrial carcinomas with known molecular profiles according to The Cancer Genome Atlas (TCGA) subgroups. Our investigation aims to clarify the potential prognostic role of tumor budding in endometrial carcinoma in contrast to other known prognostic factors, including molecular factors. In addition, the microcystic elongated and fragmented (MELF) pattern and tumor budding were compared with respect to their potential as markers for epithelial-mesenchymal transition (EMT). Tumor budding was found in n = 67 (26.3%) tumors, with a very low mean of 0.7 buds per ×20 HE field. Tumor budding was significantly associated with depth of invasion, nodal status, lymphatic invasion (each p < 0.001), grading (p = 0.004), and vascular invasion (p = 0.01). Tumor budding showed moderate inter-observer-variability with prognostic stratification irrespective of the observer (κ-value = 0.448). In multivariate analysis, tumor budding served as a significant independent prognosticator for worse outcomes in overall and recurrence-free survival (HR 2.376 and 2.736, p < 0.001), but not when the TCGA subgroups entered into the analysis. In consequence, dependency had to be clarified in the subgroup analysis for Polymerase E mutated (POLEmut), mismatch repair deficient (MMRdef), nonspecific mutation profile (NSMP), and P53 aberrant (P53abn) endometrial carcinomas. A particular impact was identified in the intermediate prognostic groups of NSMP and MMRdef carcinomas. Tumor budding outperformed the MELF pattern in single and combined prognostic information. In conclusion, the presence of tumor budding alone is a promising, robust, and easy-to-apply prognostic parameter in endometrial carcinoma. In a morpho-molecular approach, it exerts its prognostic potential in the most clinically relevant subgroups of endometrial carcinoma and serves as a good biomarker for EMT.
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68
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Ueno H, Ishiguro M, Nakatani E, Ishikawa T, Uetake H, Matsui S, Teramukai S, Murotani K, Ajioka Y, Shimazaki H, Maeda A, Takuma K, Yoshida T, Kambara T, Matsuda K, Takagane A, Tomita N, Sugihara K. Optimal Criteria for G3 (Poorly Differentiated) Stage II Colon Cancer: Prospective Validation in a Randomized Controlled Study (SACURA Trial). Am J Surg Pathol 2020; 44:1685-1698. [PMID: 32868525 PMCID: PMC7690643 DOI: 10.1097/pas.0000000000001570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Grade 3 (G3, poorly differentiated) is an important treatment-decision factor in stage II colon cancer, but no unified diagnostic criteria are established. According to previous studies, an intratumoural poorly differentiated area with no glandular formation (POR) that fills the microscopic field of a ×40 objective lens was an essential factor that defined G3. We aimed to prospectively validate this in a randomized controlled study of adjuvant chemotherapy (SACURA trial). We enrolled 991 patients with stage II colon cancer. POR was graded according to the ×40 objective lens rule and the intensity of poorly differentiated clusters (Grade), and its prognostic power was compared with that of the conventional tumor grade on the basis of predominant histology rule (Grade). According to Grade, 313, 526, and 152 tumors were classified as G1, G2, and G3, respectively, and the 5-year relapse-free survival (RFS) rates were 91.1%, 82.9%, and 74.7%, respectively (P<0.0001). When G3 and G3 were alternatively added to the prognostic model consisting of 8 conventional factors, only G3 was a significant factor for RFS (P=0.040, Wald test). The adverse impact of G3 on RFS was greater in the microsatellite stable/microsatellite instability-low subset than that in the full analysis set. In the microsatellite stable/microsatellite instability-low subset, the 5-year RFS rate of patients with G3 tumors in the chemotherapy group achieved greater improvement (9.1%) than the surgery-alone group. The least differentiation policy with the ×40 objective lens rule may be highlighted as the diagnostic criterion for G3 because of its validated prognostic value.
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Affiliation(s)
| | | | - Eiji Nakatani
- Division of Statistical Analysis of Research Support Center, Shizuoka General Hospital, Shizuoka
- Division of Medical Statistics, Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe
| | | | | | - Shigeyuki Matsui
- Department of Biostatistics, Graduate School of Medicine, Nagoya University, Aichi
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto
| | - Kenta Murotani
- Biostatistics Center, Kurume University, Graduate School of Medicine
| | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata
| | | | | | - Kunio Takuma
- Department of Surgery, Tokyo Metropolitan Tama Medical Center
| | - Takefumi Yoshida
- Department of Surgery, Social Insurance Tagawa Hospital, Fukuoka
| | | | - Keiji Matsuda
- Department of Surgery, Teikyo University School of Medicine, Tokyo
| | - Akinori Takagane
- Department of Surgery, Hakodate Goryokaku Hospital, Hokkaido, Japan
| | - Naohiro Tomita
- Department of Surgery, Division of Lower GI Surgery, Hyogo College of Medicine, Hyogo
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69
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Miyamoto Y, Hiyoshi Y, Sawayama H, Tokunaga R, Baba H. Precision medicine for adjuvant chemotherapy of resected colorectal cancer. Ann Gastroenterol Surg 2020; 4:635-645. [PMID: 33319153 PMCID: PMC7726679 DOI: 10.1002/ags3.12397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/16/2020] [Accepted: 08/05/2020] [Indexed: 12/14/2022] Open
Abstract
Colorectal cancer (CRC) is the most common cancer and the second leading cause of cancer death in Japan. Surgical resection is the only curative option for localized disease. However, undetectable micrometastases remaining after curative surgery may cause disease recurrence. Adjuvant chemotherapy aims to eradicate these micrometastases to improve the cure rate. Unfortunately, few reliable prognostic and predictive markers are available that identify patients at high risk for CRC during early-stage disease. However, promising biomarkers may become available in the near future. Such biomarkers provide information for stratifying a patient's risk and for selecting the optimal treatment. Here, we provide an overview of current relevant prognostic and predictive biomarkers applicable to adjuvant treatment of early-stage CRC and focus on the future of this field.
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Affiliation(s)
- Yuji Miyamoto
- Department of Gastroenterological SurgeryGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Yukiharu Hiyoshi
- Department of Gastroenterological SurgeryGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Hiroshi Sawayama
- Department of Gastroenterological SurgeryGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Ryuma Tokunaga
- Department of Gastroenterological SurgeryGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Hideo Baba
- Department of Gastroenterological SurgeryGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
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70
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Canguçu AL, Valério E, Peixoto RBP, Felismino TC, de Mello CAL, Neotti T, Calsavara VF, de Macedo MP, Júnior SA, Riechelmann R. The prognostic influence of tumour budding in Western patients with stage II colorectal cancer. Ecancermedicalscience 2020; 14:1130. [PMID: 33209121 PMCID: PMC7652424 DOI: 10.3332/ecancer.2020.1130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Tumour budding (TB) refers to loss of tumour cohesiveness and is defined as isolated cells or a cell cluster of up to four tumour cells at the microscopic analysis. The International Tumour Budding Consensus Conference (ITBCC) in 2016 proposed a scoring system to standardise the pathology evaluation of TB in colorectal cancer (CRC) as high (H), intermediate (I) and low (L) TB. OBJECTIVE To evaluate the recurrence-free survival (RFS) of stage II CRC patients as per the ITBCC 2016 classification and associations between TB and clinical pathological features. METHODS Cases of stage II CRC undergoing surgery with available tumour tissue underwent central pathology review for TB. Prognostic factors, retrospectively retrieved from electronic medical charts, were evaluated in univariate and multivariate Cox regression analyses for RFS (primary end point). RESULTS Among 137 patients included, L-TB was observed in 107 (78.1%), I-TB in 21 (15.3%) and H-TB in 9 (6.6%). In a median follow-up of 69 months, the median RFS was 134 months, with 14 patients (10.2%) presenting with tumour recurrence: 10 (9.3%) with L-TB, 2 (9.5%) with I-TB and 2 (22.2%) with H-TB. Perineural invasion was more commonly seen in the H-TB group. In multivariate analysis, TB (H and I versus L; HR = 2.6; p = 0.059) and not receiving adjuvant chemotherapy (HR 3.7; p = 0.020) were independently associated with RFS. Adjuvant chemotherapy was associated longer RFS (HR = 3.7; p = 0.022). CONCLUSION In this series of Western patients, TB grade was associated with perineural invasion and increased risk of disease relapse.
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Affiliation(s)
- Augusto Leite Canguçu
- Department of Clinical Oncology, AC Camargo Cancer Center, Rua Antonio Prudente 211, Sao Paulo, SP CEP: 01509-010, Brazil
| | - Ediel Valério
- Department of Pathology, AC Camargo Cancer Center, CEP: 01509-010, Brazil
| | | | - Tiago Cordeiro Felismino
- Department of Clinical Oncology, AC Camargo Cancer Center, Rua Antonio Prudente 211, Sao Paulo, SP CEP: 01509-010, Brazil
| | - Celso Abdon Lopes de Mello
- Department of Clinical Oncology, AC Camargo Cancer Center, Rua Antonio Prudente 211, Sao Paulo, SP CEP: 01509-010, Brazil
| | - Tatiane Neotti
- Department of Pathology, AC Camargo Cancer Center, CEP: 01509-010, Brazil
| | | | | | - Samuel Aguiar Júnior
- Department of Surgery Oncology, AC Camargo Cancer Center, CEP: 01509-010, Brazil
| | - Rachel Riechelmann
- Department of Clinical Oncology, AC Camargo Cancer Center, Rua Antonio Prudente 211, Sao Paulo, SP CEP: 01509-010, Brazil
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71
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Martin B, Mayr P, Ihringer R, Schäfer EM, Jakubowicz E, Anthuber M, Schenkirsch G, Schaller T, Märkl B. Interobserver Variability in the Assessment of Tumor Budding in pT 3/4 Colon Cancer: Improvement by Supporting Immunohistochemistry? Diagnostics (Basel) 2020; 10:diagnostics10090730. [PMID: 32967382 PMCID: PMC7555133 DOI: 10.3390/diagnostics10090730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/11/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022] Open
Abstract
The prognostic significance of tumor budding in colon cancer is unequivocally documented, and the recommendations of the International Tumor Budding Consensus Conference (ITBCC) are currently the accepted basis for its assessment. Up to now, it is unknown whether the general use of a supporting cytokeratin immunohistochemistry can improve the interobserver variability and prognostic significance. Six investigators with different levels of experience reassessed 229 cases of colon carcinoma (pT3/4, N+/−, M0) with a supporting cytokeratin immunohistochemistry. The results were compared to previous assessments, which have been performed only on H & E. Bd3 was significantly associated with the occurrence of distant metastases according to the assessments of three out of six investigators (p < 0.05). Only one single investigator reached significant results concerning the cancer specific survival (p = 0.01). The pairwise kappa values range between a poor and moderate level of agreement (range 0.17–0.45; median 0.21). In conclusion, the results show no superiority of the use of an additional cytokeratin immunohistochemistry compared to the conventional analysis on sole H & E slides. Therefore, the general supporting use of a cytokeratin immunohistochemical staining seems to be inadvisable in colon cancer in consideration of necessary resources and costs.
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Affiliation(s)
- Benedikt Martin
- Institute of Pathology and Molecular Diagnostics, University Medical Center Augsburg, 86156 Augsburg, Germany; (P.M.); (R.I.); (E.-M.S.); (E.J.); (T.S.); (B.M.)
- Correspondence: ; Tel.: +49-8214002151; Fax: +49-821400172150
| | - Patrick Mayr
- Institute of Pathology and Molecular Diagnostics, University Medical Center Augsburg, 86156 Augsburg, Germany; (P.M.); (R.I.); (E.-M.S.); (E.J.); (T.S.); (B.M.)
- Department of Hematology and Clinical Oncology, University Medical Center Augsburg, 86156 Augsburg, Germany
| | - Regina Ihringer
- Institute of Pathology and Molecular Diagnostics, University Medical Center Augsburg, 86156 Augsburg, Germany; (P.M.); (R.I.); (E.-M.S.); (E.J.); (T.S.); (B.M.)
| | - Eva-Maria Schäfer
- Institute of Pathology and Molecular Diagnostics, University Medical Center Augsburg, 86156 Augsburg, Germany; (P.M.); (R.I.); (E.-M.S.); (E.J.); (T.S.); (B.M.)
| | - Elżbieta Jakubowicz
- Institute of Pathology and Molecular Diagnostics, University Medical Center Augsburg, 86156 Augsburg, Germany; (P.M.); (R.I.); (E.-M.S.); (E.J.); (T.S.); (B.M.)
| | - Matthias Anthuber
- Department of Visceral Surgery, University Medical Center Augsburg, 86156 Augsburg, Germany;
| | - Gerhard Schenkirsch
- Tumor Data Management, University Medical Center Augsburg, 86156 Augsburg, Germany;
| | - Tina Schaller
- Institute of Pathology and Molecular Diagnostics, University Medical Center Augsburg, 86156 Augsburg, Germany; (P.M.); (R.I.); (E.-M.S.); (E.J.); (T.S.); (B.M.)
| | - Bruno Märkl
- Institute of Pathology and Molecular Diagnostics, University Medical Center Augsburg, 86156 Augsburg, Germany; (P.M.); (R.I.); (E.-M.S.); (E.J.); (T.S.); (B.M.)
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González IA, Bauer PS, Liu J, Chatterjee D. Intraepithelial tumour infiltrating lymphocytes are associated with absence of tumour budding and immature/myxoid desmoplastic reaction, and with better recurrence-free survival in stages I-III colorectal cancer. Histopathology 2020; 78:252-264. [PMID: 32654226 DOI: 10.1111/his.14211] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/17/2020] [Accepted: 07/09/2020] [Indexed: 12/13/2022]
Abstract
AIMS Tumour budding (TB), desmoplastic reaction (DR) and intraepithelial tumour infiltrating lymphocytes (iTILs) are recently recognised prognostic factors in colorectal cancer (CRC). In this study, we evaluated their significance and relationship to each other and their cumulative effect on survival. METHODS AND RESULTS A total of 372 stages I-III CRC cases from 2013 to 2016 were included. Low TB was identified in 302 (81%) cases, immature/myxoid DR in 67 (18%) cases and iTILs in 130 (35.0%) cases. iTILs was associated with low budding (P = 0.0247), non-myxoid DR (P = 0.0004), poorly differentiated histology (P = 0.0015), absence of perineural invasion (P = 0.0367) and loss of mismatch repair proteins (P = 0.0002). Absence of iTILs and presence of immature/myxoid DR were associated with a worse recurrence-free survival (RFS) [hazard ratio (HR) = 2.191, 95% confidence interval (CI) = 1.232-3.895; and HR = 5.706, 95% CI = 3.632-8.964, respectively]. A competing risk analysis showed statistically significant prognostic groups combining iTILs and TB (P < 0.0001). Cases with iTILs and low TB were associated with better RFS compared to cases without iTILs and with intermediate/high TB (HR = 0.214, 95% CI = 0.109-0.421). Similarly, combining iTILs and DR revealed statistically significant prognostic groups (P < 0.0001). Cases with iTILs and a non-myxoid DR had better RFS compared to cases without iTILs and immature/myxoid DR (HR = 0.113, 95% CI = 0.056-0.230). On multivariate cause-specific analysis, patients' age (P = 0.0045), iTILs (P = 0.0345), DR (P < 0.0001) and pTNM prognostic groups (P < 0.0001) were associated with RFS. CONCLUSIONS Our study validates the association of iTILs and DR as independent prognostic finding in CRC, and propose a prognostic model using the combinations of iTILs with TB and stromal reaction in CRC.
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Affiliation(s)
- I A González
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, USA
| | - P S Bauer
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - J Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - D Chatterjee
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, USA
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Abstract
Tumour budding is an emerging prognostic biomarker in colorectal cancer (CRC) and other solid cancers. Tumour buds are usually defined as isolated single cancer cells or clusters of up to four cancer cells located at the invasive tumour front. The prognostic value of tumour budding is now supported by a large body of evidence, whereas the utility of this phenotype as a predictive biomarker remains under investigation. The application of tumour budding indices in clinical practice requires a standardized scoring system that can be tailored to specific tumour types and clinical scenarios. In the context of CRC, tumour budding can be assessed according to the method agreed at the International Tumour Budding Consensus Conference (ITBCC) in 2016. Using the ITBCC scoring system, tumour budding is an independent predictor of lymph node metastasis in patients with pT1 CRC and of unfavourable survival in patients with stage II colon cancer. Regardless of the clinical scenario or tumour type, the assertion that 'the more tumour buds, the worse the clinical outcome' applies. In this Review, we provide an overview of tumour budding in solid cancers, highlighting the molecular and biological aspects of this phenomenon, including its associations with epithelial-mesenchymal transition and features of the tumour microenvironment. We also describe the available evidence demonstrating the value of tumour budding as a biomarker across various solid cancers.
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Nagata K, Shinto E, Yamadera M, Shiraishi T, Kajiwara Y, Okamoto K, Mochizuki S, Hase K, Kishi Y, Ueno H. Prognostic and predictive values of tumour budding in stage IV colorectal cancer. BJS Open 2020; 4:693-703. [PMID: 32472647 PMCID: PMC7397347 DOI: 10.1002/bjs5.50300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/22/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Tumour budding is an important prognostic feature in early-stage colorectal cancer, but its prognostic significance in metastatic disease has not been fully investigated. METHODS Patients with stage IV disease who had primary colorectal tumour resection without previous chemotherapy or radiotherapy from January 2000 to December 2018 were reviewed retrospectively. Budding was evaluated at the primary site and graded according to the criteria of the International Tumor Budding Consensus Conference (ITBCC) (BD1, low; BD2, intermediate; BD3, high). Patients were categorized by metastatic (M1a, M1b) and resectional (R0/R1, R2/unresected) status. Subgroups were compared for overall (OS) and recurrence-free (RFS) survival in R0/R1 subgroups; R2/unresected patients were evaluated for the rate of tumour progression, based on change in tumour size from baseline. RESULTS Of 371 patients observed during the study, 362 were analysed. Patients with BD3 had a lower 5-year OS rate than those with BD1 + BD2 (18·4 versus 40·5 per cent; P < 0·001). Survival analyses according to metastatic and resection status also showed that BD3 was associated with shorter OS than BD1 + BD2. In multivariable analysis, BD3 (hazard ratio (HR) 1·51, 95 per cent c.i. 1·11 to 2·10; P = 0·009), T4 status (HR 1·39) and R2/unresected status (HR 3·50) were associated with decreased OS. In the R0/R1 subgroup, the 2-year RFS rate was similar for BD3 and BD1 + BD2 according to metastatic status. There was no significant difference between BD3 and BD1 + BD2 for change in tumour size in the R2/unresected subgroup (P = 0·094). Of 141 patients with initially unresectable metastases who had chemotherapy, 35 achieved conversion from unresectable to resectable status. The conversion rate was significantly higher for BD1 + BD2 than for BD3 (36 versus 18 per cent; P = 0·016). CONCLUSION Stage IV colorectal cancer with high-grade tumour budding according to ITBCC criteria correlates with poor prognosis.
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Affiliation(s)
- K. Nagata
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
| | - E. Shinto
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
| | - M. Yamadera
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
| | - T. Shiraishi
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
| | - Y. Kajiwara
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
| | - K. Okamoto
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
| | - S. Mochizuki
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
| | - K. Hase
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
| | - Y. Kishi
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
| | - H. Ueno
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
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Parent P, Cohen R, Rassy E, Svrcek M, Taieb J, André T, Turpin A. A comprehensive overview of promising biomarkers in stage II colorectal cancer. Cancer Treat Rev 2020; 88:102059. [DOI: 10.1016/j.ctrv.2020.102059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 02/08/2023]
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The battle for prognosis at the invasive front of colorectal cancer. EBioMedicine 2020; 58:102918. [PMID: 32711249 PMCID: PMC7387774 DOI: 10.1016/j.ebiom.2020.102918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 12/15/2022] Open
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Mima K, Miyanari N, Morito A, Yumoto S, Matsumoto T, Kosumi K, Inoue M, Mizumoto T, Kubota T, Baba H. Frailty is an independent risk factor for recurrence and mortality following curative resection of stage I-III colorectal cancer. Ann Gastroenterol Surg 2020; 4:405-412. [PMID: 32724884 PMCID: PMC7382441 DOI: 10.1002/ags3.12337] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/17/2020] [Accepted: 03/20/2020] [Indexed: 12/12/2022] Open
Abstract
AIM With population aging, the number of frail patients with colorectal cancer has increased. The Clinical Frailty Scale (CFS) is a validated tool for assessing frailty, and higher scores indicate worse clinical outcomes following cardiovascular procedures. This retrospective study aimed to examine preoperative frailty in relation to recurrence and mortality following curative resection of colorectal cancer. METHODS We retrospectively analyzed data for 729 consecutive patients undergoing curative resection of stage I-stage III colon and rectal adenocarcinoma between January 2009 and December 2016. Frailty was assessed using the CFS: 1 (very fit) to 9 (terminally ill), and frailty was defined as CFS ≥ 4. Recurrence-free survival (RFS) and overall survival (OS) were compared between frail and nonfrail patients. Cox proportional hazards model was used to calculate hazard ratios (HRs), controlling for potential confounders. RESULTS CFS score was negatively correlated with the Barthel index of activities of daily living (Spearman's ρ = -0.83). Of the 729 patients, 253 (35%) were frail. In multivariable analyses adjusting for potential confounders including age and disease stage, frailty was independently associated with shorter RFS (multivariable HR: 1.70, 95% confidence interval: 1.25-2.31, P < .001) and OS (multivariable HR: 2.04, 95% confidence interval: 1.40-2.99, P < .001). There were no significant interactions of frailty with age and disease stage regarding RFS and OS (P interaction > .72). CONCLUSION Preoperative frailty was independently associated with shorter RFS and OS following resection of nonmetastatic colorectal cancer, regardless of age and disease stage. Further trials are needed to establish treatment strategies for frail patients with colorectal cancer.
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Affiliation(s)
- Kosuke Mima
- Department of SurgeryNational Hospital Organization Kumamoto Medical CenterKumamotoJapan
| | - Nobutomo Miyanari
- Department of SurgeryNational Hospital Organization Kumamoto Medical CenterKumamotoJapan
| | - Atsushi Morito
- Department of SurgeryNational Hospital Organization Kumamoto Medical CenterKumamotoJapan
| | - Shinsei Yumoto
- Department of SurgeryNational Hospital Organization Kumamoto Medical CenterKumamotoJapan
| | - Takashi Matsumoto
- Department of SurgeryNational Hospital Organization Kumamoto Medical CenterKumamotoJapan
| | - Keisuke Kosumi
- Department of SurgeryNational Hospital Organization Kumamoto Medical CenterKumamotoJapan
| | - Mitsuhiro Inoue
- Department of SurgeryNational Hospital Organization Kumamoto Medical CenterKumamotoJapan
| | - Takao Mizumoto
- Department of SurgeryNational Hospital Organization Kumamoto Medical CenterKumamotoJapan
| | - Tatsuo Kubota
- Department of SurgeryNational Hospital Organization Kumamoto Medical CenterKumamotoJapan
| | - Hideo Baba
- Department of Gastroenterological SurgeryGraduate School of Medical ScienceKumamoto UniversityKumamotoJapan
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Tumour budding and its clinical implications in gastrointestinal cancers. Br J Cancer 2020; 123:700-708. [PMID: 32601463 PMCID: PMC7462864 DOI: 10.1038/s41416-020-0954-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/17/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023] Open
Abstract
Tumour budding in colorectal cancer has become an important prognostic factor. Represented by single cells or small tumour cell clusters at the invasion front of the tumour mass, these tumour buds seem to reflect cells in a ‘hybrid’ state of epithelial–mesenchymal transition, and evidence indicates that the presence of these entities is associated with lymph node metastasis, local recurrence and distant metastatic disease. The International Tumour Budding Consensus Conference (ITBCC) has highlighted a scoring system for the reporting of tumour budding in colorectal cancer, as well as different clinical scenarios that could affect patient management. Other organs are not spared: tumour budding has been described in numerous gastrointestinal and non-gastrointestinal cancers. Here, we give an update on ITBCC validation studies in the context of colorectal cancer and the clinical implications of tumour budding throughout the upper gastrointestinal and pancreatico-biliary tract.
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79
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The presence of poorly differentiated clusters predicts survival in stage II colorectal cancer. Virchows Arch 2020; 478:241-248. [PMID: 32577812 DOI: 10.1007/s00428-020-02880-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/12/2020] [Accepted: 06/19/2020] [Indexed: 12/24/2022]
Abstract
In stage II colorectal carcinoma (CRC), adjuvant chemotherapy is reserved to cases at high risk of adverse outcome. This study aims to investigate the prognostic value of tumor budding (TB) and poorly differentiated clusters (PDC) in this setting. In a cohort of 149 patients with surgically resected stage II CRC not undergoing neoadjuvant or adjuvant treatments, we assessed the prognostic value of several clinical-pathological variables, including PDC and TB, on cancer-specific survival (CSS). Rectal location, lymphovascular invasion, and a number of lymph nodes < 12 confirmed to be significant and independent predictors of shorter CSS. A total of 117 CRCs were graded as PDC-G1 (0-4 PDCs), 19 as PDC-G2 (5-9 PDCs), and 13 as PDC-G3 (> 9 PDCs). Ninety-eight cases had PDC absent. TB foci were found in 91 CRCs; 121 were classified Bd1, 16 were Bd2, and 12 were Bd3. PDC-G2/G3 was significantly prognostic of shorter CSS (P < 0.0001). Among PDC-G1 cases, the presence of PDC was significantly associated with reduced CSS (P < 0.0001). Moreover, in the whole 149 CRCs, it had higher sensitivity and specificity to identify high-risk patients, compared to PDC grade, and it was independently associated with shorter CSS at multivariate analysis. High TB grade (Bd3) was significantly associated with shorter CSS (P = 0.0001), but it lost prognostic value at multivariate analysis. These findings suggest that the presence of PDC in stage II CRCs might be added to the pool of high-risk factors, warranting the use of adjuvant chemotherapy.
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80
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Mima K, Kurashige J, Miyanari N, Morito A, Yumoto S, Matsumoto T, Kosumi K, Inoue M, Mizumoto T, Kubota T, Baba H. Advanced Age Is a Risk Factor for Recurrence After Resection in Stage II Colorectal Cancer. In Vivo 2020; 34:339-346. [PMID: 31882497 DOI: 10.21873/invivo.11779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIM The number of older patients with colorectal cancer (CRC) is increasing. Stage II CRC is a heterogeneous group of cancers with different prognoses. We aimed to examine older patients in relation to clinical outcome following curative resection in stage II CRC. PATIENTS AND METHODS We analyzed data for 329 consecutive patients with stage II CRC following curative resection. Recurrence-free survival (RFS) and overall survival (OS) were compared between older patients ≥75 years of age and those <75 years. Cox proportional hazards model was used to compute hazard ratios (HRs) controlling for potential confounders. RESULTS In the multivariable analyses, patients ≥75 years were independently associated with shorter RFS (multivariable HR=2.56, 95% confidence interval (CI)=1.55-4.31, p<0.001) and OS (multivariable HR=4.36, 95%CI=2.08-9.97, p<0.001) in stage II CRC. CONCLUSION Older patients were independently associated with shorter RFS and OS following curative resection in stage II CRC.
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Affiliation(s)
- Kosuke Mima
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Junji Kurashige
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Nobutomo Miyanari
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Atsushi Morito
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Shinsei Yumoto
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Takashi Matsumoto
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Keisuke Kosumi
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Mitsuhiro Inoue
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Takao Mizumoto
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Tatsuo Kubota
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
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Neppl C, Zlobec I, Schmid RA, Berezowska S. Validation of the International Tumor Budding Consensus Conference (ITBCC) 2016 recommendation in squamous cell carcinoma of the lung-a single-center analysis of 354 cases. Mod Pathol 2020; 33:802-811. [PMID: 31796876 DOI: 10.1038/s41379-019-0413-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 01/17/2023]
Abstract
There are no universally accepted grading systems in pulmonary squamous cell carcinoma (pSQCC). Recently, tumor budding, cell nest size, and spread through airspaces (STAS) have been proposed as grading scheme candidates. Tumor budding is a well-established independent prognostic factor in colorectal cancer. The International Tumor Budding Consensus Conference (ITBCC) provided consensus on scoring in 2016, albeit for colorectal cancers. Here, we aimed to validate the ITBCC method in pSQCC and evaluate additional proposed grading parameters. We analyzed a fully clinico-pathologically annotated Western single-center cohort of 354 consecutive primary resected pSQCC (resected 2000-2013). Patients with SQCC of other organs were excluded to reliably exclude lung metastases. We assessed conventional grading, keratinization, STAS, and tumor budding according to ITBCC recommendations, and correlated them with clinico-pathological parameters and survival. Tumor budding was low (0-4 buds/0.785 mm2) in 41%, intermediate (5-9 buds/0.785 mm2) in 30%, and high (≥10 buds/0.785 mm2) in 29% of cases (mean bud count = 7.45 (H&E), min = 0, max = 84). Cell nests of 1, 2-4, 5-15, >15 cells were present in 68%, 20%, 5%, 7%, respectively. We detected STAS in 33% of cases, desmoplasia in 68%. Tumor budding assessed as continuous and categorized variables was highly concordant between hematoxylin and eosin (H&E) and pancytokeratin (AE1/AE3) stained slides (P < 0.001) and significantly associated with tumor size, UICC/AJCC pT, pN, stage (all P < 0.001) and presence of mediastinal lymph node metastases (H&E: P = 0.028). Tumor budding was a significant prognostic parameter for overall, disease-specific, and progression-free survival (PFS) (all P < 0.001). ITBCC tumor budding categories were independent prognostic factors for overall survival (HR = 1.581; 95% CI 1.186-2.108; P = 0.002), disease-specific survival (HR = 1.710; 95% CI 1.111-2.632; P = 0.015), and PFS (HR = 1.457; 95% CI 1.123-1.890; P = 0.005). STAS or conventional tumor grade had no prognostic value. In conclusion, we confirm tumor budding as an independent prognostic marker in pSQCC and validate the ITBCC 2016 scoring recommendations in pSQCC.
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Affiliation(s)
- Christina Neppl
- Institute of Pathology, University of Bern, Murtenstrasse 31, 3010, Bern, Switzerland
| | - Inti Zlobec
- Institute of Pathology, University of Bern, Murtenstrasse 31, 3010, Bern, Switzerland
| | - Ralph A Schmid
- Division of General Thoracic Surgery, Inselspital University Hospital Bern, Bern, Switzerland
| | - Sabina Berezowska
- Institute of Pathology, University of Bern, Murtenstrasse 31, 3010, Bern, Switzerland.
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Shinto E, Yoshida Y, Ueno H. ASO Author Reflections: Gene Signature Generated from Tumor Budding-A New Molecular Marker of Recurrence Risk. Ann Surg Oncol 2020; 27:4055-4056. [PMID: 32342297 DOI: 10.1245/s10434-020-08505-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Eiji Shinto
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
| | | | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
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83
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Shinto E, Yoshida Y, Kajiwara Y, Okamoto K, Mochizuki S, Yamadera M, Shiraishi T, Nagata K, Tsuda H, Hase K, Kishi Y, Ueno H. Clinical Significance of a Gene Signature Generated from Tumor Budding Grade in Colon Cancer. Ann Surg Oncol 2020; 27:4044-4054. [PMID: 32328985 DOI: 10.1245/s10434-020-08498-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Tumor budding, a microscopic finding of dedifferentiation at the invasive margin, has been reported as a definite prognostic marker in colon cancer (CC). Herein, we aimed to generate a molecular budding signature (MBS) based on DNA microarray data and to examine its prognostic significance. METHODS Frozen tissue samples from 85 patients with stage II/III CC were used for DNA microarray analyses. First, we selected candidate genes that were differentially expressed (twofold change) between the invasive frontal regions and corresponding tumor centers of three extremely high-grade budding tumors. Subsequently, using microarray data from whole-tissue sections of the 85 patients, we selected MBS-constituent genes from the candidates based on correlation to the pathological budding grade. The MBS score was calculated using the sum of the logarithm of the expression of each gene. RESULTS We selected seven MBS-constituent genes: MSLN, SLC4A11, WNT11, SCEL, RUNX2, MGAT3, FOXC1. A comparison of relapse-free survival (RFS) rates revealed a significant impact of the MBS score [5-year RFS, 77.4% (score-high) vs. 95.1% (score-low); P = 0.044]. Analyses of public databases revealed that low MBS score patients exhibited better prognosis than those with high-score cancers (GSE14333: 5-year RFS, 83.1% vs. 66.6%, P = 0.028; GSE39582: 5-year disease-free survival, 72.2% vs. 58.1%, P = 0.0005). Multivariate analysis revealed that the MBS score is an independent prognostic indicator in GSE39582 (hazard ratio, 1.611; P = 0.013). CONCLUSIONS We developed a new gene classification method, i.e., MBS, and demonstrated its clinical relevance as an indicator of high recurrence risk of CC.
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Affiliation(s)
- Eiji Shinto
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
| | | | - Yoshiki Kajiwara
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Koichi Okamoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Satsuki Mochizuki
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masato Yamadera
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Takehiro Shiraishi
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Ken Nagata
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hitoshi Tsuda
- Department of Pathology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
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Abe T, Sakai H, Hayashi M, Nakamura S, Takesue S, Sada M, Kozono S, Kitaura Y, Tanabe Y, Nishihara K, Mine M, Tamiya S, Nakano T. Intramural metastasis to the appendix from ascending colon cancer: a case report. Surg Case Rep 2020; 6:69. [PMID: 32277313 PMCID: PMC7148412 DOI: 10.1186/s40792-020-00829-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/26/2020] [Indexed: 01/03/2023] Open
Abstract
Background Intramural metastasis is rare in colorectal cancer, especially metastasis of ascending colon cancer to the appendix. Case presentation A 64-year-old man was admitted to our hospital for surgery for ascending colon cancer detected by medical examination. Colonoscopy identified a type-2 tumor in the ascending colon, which was diagnosed as adenocarcinoma. Abdominal computed tomography revealed focal thickening of the ascending colon and middle of the appendix and swelling of the lymph nodes around the ileocolic artery. The patient underwent laparoscopic right hemi-colectomy with D3 lymph node dissection. Histopathological findings revealed that the ascending colon cancer was moderately differentiated adenocarcinoma with lymphatic and vascular invasion (stage IIIB; pT3N2M0). Additionally, moderately differentiated adenocarcinoma was observed mainly in the submucosa and muscularis propria of the appendix, which was approximately 10 cm proximal to the ascending colon cancer. These findings indicated intramural metastasis to the appendix from the ascending colon cancer. The patient experienced recurrence with lung metastasis 2.5 years after the first surgery. Conclusions Intramural metastasis of ascending colon cancer to the appendix is extremely rare. Because the risk of recurrence and the prognosis for intramural metastasis has not been clarified, careful follow-up is recommended.
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Affiliation(s)
- Toshiya Abe
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan.
| | - Hiroshi Sakai
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
| | - Masataka Hayashi
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
| | - So Nakamura
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
| | - Shin Takesue
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
| | - Masafumi Sada
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
| | - Shingo Kozono
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
| | - Yoshiki Kitaura
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
| | - Yoshitaka Tanabe
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
| | - Kazuyoshi Nishihara
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
| | - Mari Mine
- Department of Pathology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Sadafumi Tamiya
- Department of Pathology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Toru Nakano
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
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Are tumour grade and tumour budding equivalent in colorectal cancer? A retrospective analysis of 771 patients. Eur J Cancer 2020; 130:139-145. [PMID: 32200222 DOI: 10.1016/j.ejca.2020.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/03/2020] [Accepted: 02/08/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Tumour grade is traditionally considered in the management of patients with colorectal cancer. However, a large body of literature suggests that a related feature, namely tumour budding, may have a more important clinical impact. The aim of our study is to determine the correlation between tumour grade and tumour budding and their impact on patient outcome. METHODS A retrospective collective of 771 patients with colorectal cancer were included in the study. Clinicopathological information included tumour grade (World Health Organisation 2010; G1, G2 and G3) and tumour budding evaluated as BD1, BD2 and BD3 and representing 0-4 buds, 5-9 buds and 10 or more buds per 0.785 mm2, respectively. RESULTS Tumour grade and tumour budding were correlated (p < 0.0001, percent concordance: 33.8%). Of the BD1 cases, 18.1% were of G3. Only two BD3 cases were G1. Both high tumour grade and tumour budding were associated with higher pT, lymph node metastasis, distant metastasis and lymphatic and venous vessel invasion (p < 0.01, all), but only tumour grade was additionally associated with right-sided tumour location and mucinous histology. Higher tumour budding led to worse overall (p = 0.0286) and disease-free survival (p = 0.001), but tumour grade did not. Budding was independent of tumour grade in multivariate analysis. DISCUSSION Tumour grade and tumour budding are distinct features, as recognised by their different clinicopathological associations, reflecting different underlying biological processes. Nonetheless, tumour budding seems to outperform tumour grade in terms of predicting disease-free survival.
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Banias L, Jung I, Bara T, Fulop Z, Simu P, Simu I, Satala C, Gurzu S. Immunohistochemical-based molecular subtyping of colorectal carcinoma using maspin and markers of epithelial-mesenchymal transition. Oncol Lett 2020; 19:1487-1495. [PMID: 31966075 PMCID: PMC6956164 DOI: 10.3892/ol.2019.11228] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/15/2019] [Indexed: 02/07/2023] Open
Abstract
The aim of the present study was to classify colorectal carcinoma (CRC) into molecular subtypes, based on immunohistochemical (IHC) assessments. A total of 112 CRC samples were molecularly classified based on the expression levels of epithelial-mesenchymal transition (EMT)-associated IHC markers. A total of three molecular subtypes were defined: Epithelial, membrane positivity for E-cadherin and β-catenin, negative for vimentin; mesenchymal, E-cadherin-negative, nuclear β-catenin- and vimentin-positive; and hybrid cases, epithelial tumor core and mesenchymal tumor buds. Most of the cases were diagnosed as moderately differentiated adenocarcinoma (n=89; 79.46%). The majority of cases (n=100; 89.28%) exhibited a mismatch repair proficient status (microsatellite stable CRCs). A predominance of epithelial-type (n=51; 45.54%) and hybrid CRCs (n=47; 41.96%) was observed, whereas a few cases (n=14; 12.50%) were classified as mesenchymal-type CRCs. This molecular classification was associated with pathological stage (P<0.01), pT stage (P=0.04), pN stage (P<0.01), the grade of tumor budding (P=0.04), and maspin expression in both the tumor core (P=0.04) and the invasion front (P<0.01). The mesenchymal-type cases predominantly exhibited lymph node metastases, high-grade budding and a tendency towards maspin nuclear predominance. All epithelial-type cases with maspin-only expression (n=18) were non-metastatic. Patients with CRC of the epithelial subtype and those with a lymph node ratio (LNR) ≤0.15 presented the best overall survival, followed by those with hybrid and mesenchymal subtypes. Nuclear maspin positivity was more frequent in cases with a high-budding degree compared with those with a low-budding degree (P=0.03). The EMT-associated molecular classification of CRCs may be used to identify the most aggressive CRCs, which show a mesenchymal phenotype, high-budding degree, maspin nuclear positivity and lymph node metastases. The pN stage, LNR and budding degree of patients, which can be evaluated with maspin expression, remain the most important prognostic factors.
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Affiliation(s)
- Laura Banias
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, ‘George Emil Palade’, 540139 Targu-Mures, Romania
| | - Ioan Jung
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, ‘George Emil Palade’, 540139 Targu-Mures, Romania
| | - Tivadar Bara
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, ‘George Emil Palade’, 540139 Targu-Mures, Romania
| | - Zsolt Fulop
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, ‘George Emil Palade’, 540139 Targu-Mures, Romania
| | - Patricia Simu
- Department of Radiology, University of Medicine, Pharmacy, Sciences and Technology, ‘George Emil Palade’, 540139 Targu-Mures, Romania
| | - Iunius Simu
- Department of Radiology, University of Medicine, Pharmacy, Sciences and Technology, ‘George Emil Palade’, 540139 Targu-Mures, Romania
| | - Catalin Satala
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, ‘George Emil Palade’, 540139 Targu-Mures, Romania
| | - Simona Gurzu
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, ‘George Emil Palade’, 540139 Targu-Mures, Romania
- Research Center (CCAMF)-Microscopy Laboratory, University of Medicine, Pharmacy, Sciences and Technology, ‘George Emil Palade’, 540139 Targu-Mures, Romania
- Correspondence to: Professor Simona Gurzu, Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, ‘George Emil Palade’, 38 Ghe Marinescu Street, 540139 Targu-Mures, Romania, E-mail:
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Blank A, Schenker C, Dawson H, Beldi G, Zlobec I, Lugli A. Evaluation of Tumor Budding in Primary Colorectal Cancer and Corresponding Liver Metastases Based on H&E and Pancytokeratin Staining. Front Med (Lausanne) 2019; 6:247. [PMID: 31737639 PMCID: PMC6834648 DOI: 10.3389/fmed.2019.00247] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 10/15/2019] [Indexed: 01/01/2023] Open
Abstract
In colorectal cancer, tumor budding is associated with tumor progression and represents an additional prognostic factor in the TNM classification. Tumor buds can be found at the invasive front (peritumoral budding; PTB) and in the tumor center (intratumoral budding; ITB) of primary tumors. Previous studies have shown that tumor buds are also present in colorectal liver metastases (CRLM). Data on the prognostic and predictive role in this clinical context are still sparse and no standardized approach to evaluate budding in CRLM has been published so far. This study aimed to analyze and correlate perimetastatic (PMB) and intrametastatic budding (IMB) on H&E and pancytokeratin staining, compare it to budding results in corresponding primary tumors and to propose a standardized scoring system in CRLM as the basis for future studies. Tumor tissue of 81 primary tumors and 139 corresponding CRLM was used for ngTMA construction. For each primary tumor and metastasis, two punches from the center and two punches from the periphery from areas with highest tumor budding density were included. TMA slides were stained for H&E and pancytokeratin (Pan-CK). PTB, ITB, PMB, and IMB were analyzed and classified as bd1, bd2, and bd3 according to ITBCC guidelines. ITB and PTB as well as IMB and PMB showed significant correlation on H&E and Pan-CK staining. No correlation was found for tumor bud counts in primary tumors and corresponding metastases. The agreement for categorized tumor bud counts showed fair to good agreement for metastases and poor agreement for primary tumors between different classes on H&E and Pan-CK staining. Based on our results, tumor budding in primary tumors and CRLM seems to be different processes which might be the results of differing surrounding microenvironments. The evaluation of tumor budding in CRLM is challenging in cases without desmoplastic stroma reaction or intense perimetastatic ductular reaction. We therefore propose to evaluate tumor budding only in metastases with desmoplastic stroma reaction based on H&E staining since important morphological features are obscured on Pan-CK staining.
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Affiliation(s)
- Annika Blank
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Carla Schenker
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Heather Dawson
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Inti Zlobec
- Institute of Pathology, University of Bern, Bern, Switzerland
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